自身免疫性肝炎和原发性胆汁性胆管炎患者甲状腺功能变化及其对治疗应答的影响*

doi:10.3969/j.issn.1672-5069.2024.01.014

摘要/Abstract

摘要： 目的分析自身免疫性肝炎(AIH)和原发性胆汁性胆管炎(PBC)患者甲状腺功能、抗甲状腺抗体变化及其对治疗应答的影响。方法 2020年1月～2022年1月我院诊治的AIH患者30例、PBC患者28例和同期健康体检者32例,分别给予患者标准的免疫抑制或熊去氧胆酸治疗。常规检测血清三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平,采用放射受体法检测血清抗甲状腺素受体抗体(TRAb)、抗甲状腺过氧化物酶抗体(TPO-Ab)、抗甲状腺球蛋白抗体(TGAb)、甲状腺素结合球蛋白(TBG)和甲状腺球蛋白(TG)。结果 AIH组血清FT3和FT4水平分别为(4.2±0.2)pmol/L和(13.8±1.9)pmol/L,PBC组分别为(4.3±0.3)pmol/L和(13.9±1.3)pmol/L,均显著低于健康人【分别为(4.9±0.6)pmol/L和(15.9±4.2)pmol/L,P＜0.05】,而AIH组和PBC组血清TSH水平分别为(3.8±1.2)mIU/L和(3.7±0.5)mIU/L,均显著高于健康人【(2.6±0.5)mIU/L,P＜0.05】;AIH组血清TPO-Ab和TG阳性率分别为33.3%和26.7%,PBC组分别为39.3%和25.0%,均显著高于健康人的9.4%和3.1%(P＜0.05);经过1年的治疗,AIH组生化学应答率为66.7%,PBC组为75.0%;两种疾病应答组血清FT3和FT4水平显著高于未应答组,而血清TSH水平及TPO-Ab和TG阳性率显著低于未应答组,差异有统计学意义(P＜0.05)。结论 AIH和PBC患者都可能存在甲状腺功能减退,并影响治疗应答,临床应予以重视筛查和处理。

关键词: 自身免疫性肝炎, 原发性胆汁性胆管炎, 甲状腺功能, 抗甲状腺抗体, 治疗, 应答

Abstract: Objective The study was conducted to analyze the changes of thyroid functions and their impact on response to standardized therapy in patients with autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC). Methods 30 patients with AIH, 28 patients with PBC and 32 volunteers were recruited in our hospital between January 2020 and January 2022, and the patients with AIH or with PBC were treated by standardized immunosuppression or ursodeoxycholic acid therapy. Serum total-triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), free thyroxine T4 (FT4) and thyroid-stimulating hormone (TSH) levels were routinely detected. Serum anti-thyroglobulin antibodies (TRAb), thyroid-peroxidase antibody (TPO-Ab), anti-thyroglobulin antibodies (TGAb), thyroxine-binding globulin (TBG) and thyroglobulin (TG) were also determined by radioimmunoassay. Results Serum FT3 and FT4 levels in patients with AIH were (4.2±0.2)pmol/L and (13.8±1.9)pmol/L, and in patients with PBC were (4.3±0.3)pmol/L and (13.9±1.3)pmol/L, significantly lower than [(4.9±0.6)pmol/L and (15.9±4.2)pmol/L, respectively, P＜0.05], while serum TSH levels in patients with AIH and in with PBC were (3.8±1.2)mIU/L and (3.7±0.5)mIU/L, significantly higher than [(2.6±0.5)mIU/L, P＜0.05] in healthy volunteers; serum TPO-Ab and TG positive rates in patients with AIH were 33.3% and 26.7%, and in patients with PBC were 39.3% and 25.0%, all significantly higher than 9.4% and 3.1%(P＜0.05) in healthy individuals; at the end of one-year treatment, the response rates to treatment in patients with AIH was 66.7% and in patients with PBC was 75.0%; serum FT3 and FT4 levels in responders no matter in AIH or PBC were significantly higher than, while serum TSH levels as well as serum TPO-Ab and TG positive rates were much lower than in non-responders(P＜0.05). Conclusion The hypothyroidism could occur in patients with autoimmune liver diseases, which might influence the response to standardized therapy, and warrants clinical careful surveillance.

Key words: Autoimmune hepatitis, Primary biliary cholangitis, Thyroid functions, Anti-thyroglobulin antibodies, Therapy, Response

闫玉婷, 贾桂, 孟琴, 高欣欣. 自身免疫性肝炎和原发性胆汁性胆管炎患者甲状腺功能变化及其对治疗应答的影响^*[J]. 实用肝脏病杂志, 2024, 27(1): 52-55.

Yan Yuting, Jia Gui, Meng Qin, et al. Thyroid functions and their impact on response to standardized therapy in patients with autoimmune hepatitis and primary biliary cholangitis[J]. Journal of Practical Hepatology, 2024, 27(1): 52-55.

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自身免疫性肝炎和原发性胆汁性胆管炎患者甲状腺功能变化及其对治疗应答的影响^*

Thyroid functions and their impact on response to standardized therapy in patients with autoimmune hepatitis and primary biliary cholangitis

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